Prevalence and Risk Factors for High-Risk Human Papillomavirus Infection and Cervical Disorders: Baseline Findings From an Human Papillomavirus Cohort Study

Abstract

Background: A persistent infection by high-risk human papillomavirus (HR-HPV) is a prerequisite for the development of cervical neoplasms; however, most studies have focused on risk factors associated with HPV-16 and HPV-18 only.

Objectives: We assessed the association of risk factors with the prevalence of HPV-16, HPV-18, and non-16/18 HR-HPV infection and with the occurrence of cervical lesions in the baseline of a cohort study of HPV persistence in a Mexican population.

Methods: Cross-sectional study within the baseline of a 5-year dynamic cohort study of HR-HPV persistence in women with an abnormal cytology study result from 2015 to 2021. HPV DNA was detected using the Anyplex II HPV 28 kit. Data on lifestyle, sociodemographic, and reproductive factors were assessed using bivariate and multivariate analyses to determine the association of risk factors with HR-HPV infection status and histopathologic diagnosis.

Results: A total of 373 women were included in the study. The overall prevalence of HR-HPV infection was 69.97%. The most prevalent HR-HPV genotypes, including single and multiple infections, were HPV-53 (13.4%), HPV-16 (11.8%), HPV-58 (10.9%), HPV-31 (10.9%), and HPV-66 (10.7%). We found 90 multiple HR-HPV infection patterns, all of them with α-6 and -9 species. Significant associations of multiple HPV-16 and non-16/18 HR-HPV infections were found with marital status, number of lifetime sexual partners, and smoking history. The most prevalent genotype in CIN1 and CIN2 patients was HPV-16. No association was found between biological plausibility risk factors and cervical lesions.

Conclusions: The risk factors for non-16/18 HR-HPV multiple infections are no different than those linked to HPV-16 multiple infections.

Keywords: cervical neoplasm; human papillomavirus infection; risk factors; squamous intraepithelial lesions.

Figure 1.

Distribution of high-risk HPV genotypes in single and multiple infection.

Figure 2.

Age-specific prevalence of any HR-HPV genotype. HR-HPV prevalence is defined as the percentage of women with at least one high-risk HPV genotype detected (including coinfections with other HR-HPV genotypes).

Figure 3.

Distribution of prevalence of high-risk HPV genotypes for single and multiple infection.

Figure 4.

Heat map: Patterns of high-risk HPV infection. Heat map of the patterns of multiple HR-HPV infections. Horizontal and vertical axes represent the 28 high-risk genotypes that were evaluated in each patient. Blue cells indicate a higher number of combinations, and yellow cells indicate a lower number of combinations for each infection pattern. The color scale progresses from yellow to blue as the number of patterns per genotype increases. As shown, genotype 53 has the highest number of combinations.